Far from being a disease, anovulation is only a sign that there`s a problem in the reproductive female system.
Anovulation is a major impediment for a lot of women that want to become pregnant and can be based on lots of causes. Fortunately, once they are identified, these can be resolved and ovulation be restored, thus leading to pregnancy.
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What Does Anovulatory Mean?
Ovulation is a complex process, starting with ovarian follicle maturation and ending with follicle rupture and expulsion of the mature egg outside the ovary. This process is controlled by the hypothalamic-pituitary-gonadal axis and is the result of a complicated hormonal game, whose disorder, no matter the level, is related to the lack of ovulation (anovulatory cycles).
Therefore, anovulation is rather a sign and not a disease, being the end result of several types of affections. It translates into irregular or absent menstrual cycles and infertility.
To understand anovulation, we first need to understand what`s happening during a normal ovulation cycle. The ovaries cannot function normally without being stimulated by the pituitary gland, located at the base of the skull under the cerebral hemispheres. In turn, the latter`s function is dependent of the functional stimulation by another structure, known as hypothalamus, located in the immediate vicinity.
The pituitary gland synthesizes and secretes 2 hormones known as FSH (follicle stimulating hormone) and LH (luteinizing hormone), which controls ovarian function, inducing ovarian hormonal synthesis (mainly estrogen, progesterone, testosterone and other hormones) and ovarian follicle maturation. A disorder no matter how small of this sensitive system leads to the absence of ovulation. The disorder might be in the neuroendocrine component (pituitary gland or hypothalamus) or in the ovaries.
In the first part of the ovulatory menstrual cycle, under the influence of pituitary hormones, the ovarian follicle grows and matures and the ovary`s hormones are synthesized, mainly estrogens. Estrogens will produce a thickening of the endometrium (the mucosa which licks the uterus on the inside to create favorable conditions for implantation of a possibly fertilized egg).
The increasing estrange levels produce, through a positive feedback, a stimulation of the pituitary LG synthesis, which suddenly increased in the mid-cycle and triggers the ovulation process, meaning breaking the follicle and expelling the mature egg into the uterus.
After ovulation, what remains of the follicle after the expulsion turns into a yellow (or luteal), which will secrete progesterone. Progesterone will stabilize and prepare the endometrium for the egg`s implantation in the event of a possible pregnancy. – More similar info!
If there`s no fertilization and implantation of the egg, ovarian hormone secretion decreases and towards the menstrual cycle`s end, the thickened endometrium, lacking any hormonal support, will break down and be removed from the uterus as menstrual bleeding. Then a new menstrual cycle will follow, with the same hormonal fluctuations in a precise game, whose disorder may lead to the absence of ovulation.
What Is an Anovulatory Cycle?
An anovulatory cycle is the menstrual cycle that is characterized by various degrees of intervals as well as a luteal phase and the absence of ovulation. When absence of ovulation is concerned, we can talk about infertility.
While when a normal menstrual cycle is concerned, we can talk about one that lasts 4 weeks, meaning 28 days (ranging from 21 to 35 days) and consists of luteal phase, follicular phase and ovulation, followed by pregnancy or menstruation, when an anovulatory cycle is concerned, we have lengths of cycle of various degrees. In a lot of circumstances, the intervals exceed 35 days, often leading to oligomenorrhea, or even longer, leading to amenorrhea. In other situations, menstruation might be somehow regular (eumenorrhea), or more often with intervals of <21 days, or there might even be a loss of pattern in the menstrual cycle (menorrhagia or dysfunctional uterine bleeding)
Causes of Anovulation
Some causes of lack of ovulation are easily identifiable, other ones more difficult. According to more experts, the most frequent causes are as follows:
- Too many weight loss exercises or harsh diets. A long exercises program, like running may interfere with the ovulation cycle of a woman. This type of anovulation is known as amenorrhea. Typically, ovulation returns when the woman feeds properly, according to the needs of her body.
- Stress. Anxiety and other forms of emotional stress may also affect ovulation. In a busy daily life, some women may cope with daily stress, while others need to consult a psychiatrist. This medical condition also negatively affects ovulation. Healing can be done through specialized therapy or meditation.
- Certain drugs. Another possible cause for anovulation is the long-term use of particular medications. In this category, we also remind birth control pills, which as it`s already known, prevent ovulation. In women using injections, it seems that their prolonged use leads to amenorrhea.
- Other causes. This includes thyroid gland dysfunction, ovarian cysts, premenopause or hypothalamic dysfunctions. Causes of anovulation can be determined by a blood test. In some cases, ultrasound and even laparoscopy might be needed.
What Symptoms Precedes Anovulation?
The first and most obvious is the disruption of the menstrual cycle followed, in very extreme cases, by its definitive cessation (but not irreversible). A symptom of anovulation can also be a short menstruation or which lasts more than usual.
It`s also possible that the period of menstruation doesn`t vary by more than 1 – 2 days, yet ovulation doesn`t occur. In this situation, we will talk about an anovulatory cycle which can cause other hormonal disturbances associated with it.
Fluctuations in body temperature are a symptom of anovulation, and lack or reduction of premenstrual syndrome, abnormal bleeding during period or even bleeding.
How Can Anovulation Be Detected?
It`s a good idea for your doctor to want to see the baseline temperature indices for a few months. This will mean that every morning, before getting out of bed and eating or drinking anything, you have to use a thermometer to observe the values of fear. If it indicates significant fluctuations, it might be anovulation.
If you don`t have enough time and patience to wait, your doctor may recommend you a ultrasound that will quickly detect any issue in the reproductive system or the low volume or ovarian follicles.
How to Treat Anovulation?
The treatment is intended to restore normal ovulation by various ways depending on the cause and any specific demands. Therefore, you can track the increase or weight loss (when applicable, even a 10% weight loss can help to restore ovulation), reduce the intensity of physical effort, and prescription for:
- Regulation of the menstrual cycle – through a combined oral contraceptive pill, persons who cannot tolerate them can get hormonal pills for 2 or 3 weeks on each menstrual cycle, which prevents bleeding during use, thus allowing menstruation to occur only at intervals they aren`t used.
- Ovulation induction tablets – is the first line of treatment and consists of Clomid (50 mg daily for 5 days starting on the second day of menstruation; when there`s estrogen production; it stimulates the pituitary gland to released gonadropins; studies show a percentage of 42% – 57% of ovulation and 31% of pregnancy after use, some with an efficiency of more than 80% and respectively 42%; if ovulation doesn`t occur after 7 days of treatment, the dose of 50 mg/day needs to be adjusted up to 150 mg/day; the maximum duration of administration is of 6 months); women who suffer of SOPC can receive every day constantly (around 6 months, insulin sensitization).
- Ovulation induction injections – on a daily basis from the second day of menstruation for 10 to 14 days (sometimes even 21 days) depending on the response of each woman`s body. It needs constant blood test/ultrasound to reduce the risk of over-stimulation; present a risk of bloating and abdominal discomfort. The efficiency in ovulation is of 90% and between 20% and 60% for pregnancy.
Corticosteroids can sometimes be used when treating anovulation if it`s an excessive male hormone level produced by the adrenal gland. If the cause is premature ovarian insufficiency or low ovarian reserve, the medication is unlikely to function, the doctor deciding in these situations an egg donation or an alternative to a family such as adoption. It might be rather helpful to consult a fertility specialist. – Visit us here!
After these treatments, ¾ of women will regain their normal ovulation, half of them even being able to remain pregnant. However, a common risk consists in the occurrence of multiple pregnancies in 25% of women (when using Clomid, the chances, the chances in the general population of gemelar pregnancy is 1%) and the occurrence of ovarian hyperstimulation syndrome. Also, these drugs make cervical mucus “hostile” for sperm, preventing it from reaching the uterus; it might even be necessary to use artificial insemination or IVF.